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APPLICATION UNDERGROUND STATE IO NUMBER <br /> ( ) O1 NEW PERMIT <br /> ( ) 02 CONDITIONAL PERMIT ( STORAGE TANK 00000019743001 <br /> ) 05 RENEWED PERMIT FOR PERMIT TO OPERATE <br /> ( ) 06 AMENDED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 08 MINOR CHANGE (NO SURCHARGE) 09 DEL <br /> I OWNER EE) <br /> NAME(CORFORATION"NDIVIDUAL <br /> E.F. MITCHLER CO OR PUBLIC AGENCY) <br /> STREET ADDRESS PUBLIC AGENCY ONLY <br /> 400 S. LINCOLN ST ( ) 01 FED [ ) 02 STATE ( ) 03 LOCAL <br /> CITv <br /> STOCKTON STATE ZIP <br /> II FACILITY CA 95203 <br /> FACILITY NAME <br /> JERRY JOY & ASSOCIATE <br /> DEALER/FOREMAN/SUPERVISOR <br /> STREET ADDRESS <br /> 1000 N. UNION ST, <br /> NEAREST CROSS STREET <br /> Cirr ACACIA <br /> STOCKTON <br /> COUNTY <br /> MAILING ADDRESS SAN JOAQUIN ZIP <br /> 3028 CANAL DRIVE CITY 95205 <br /> PHONE W/APEA CODE STOCKTON STATE ZIP <br /> 209-462-1481 TYPEOF BUSINESS CA 95204 <br /> NUMBER OP CONTAINERS <br /> ( ) 01 GASOLINE STATION (X) 02 OTHER <br /> 1 RURAL AREAS ONLY : TOWNSHIP <br /> RANGE <br /> SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME( AST NAME FIRST) AND PHONE W/AREA CODE <br /> KLEIN, RO T 209-466-8941 NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> KLEIN, ROBERT <br /> 209-478-5528 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: <br /> CONTAINER NUMBER 7 <br /> B. MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: C. YEAR INSTALLED <br /> (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( �UWNOWN <br /> JEOOES THE CONTAINER STORE: ( ) O1 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL O( IE05 WASTE 2OIL (I) 06 YES06 <br /> APPROPRIATE BOX(ES): <br />( CONTAINER CONSTRUCTION <br /> THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES [ 7 CM (X) UNKNOWN <br /> ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> ( ) <br /> 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS f ) <br /> ) 06 N <br /> 04 POLYVINYL CHLORIDE <br /> (X) 12 UNKNOWN ( ) 05 CONCRETE <br /> ( NOON 1 ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ) OTHER: <br />(14-070185 (10/18/85) <br /> PAGE 1 <br />